UPMC Hillman Cancer Center Medical Physics Residency Program 1 | P a g e

Clinical Rotation Summaries:

Each mentor is responsible for explaining material content related to the objective and

prepare assignments for the resident, which need to be completed for the competency. Sufficient

clinical knowledge is deemed to be demonstrated by the resident when independent performance

and critical thinking is displayed. Independent performance is accomplished by completing

competency tasks assigned by the mentor.

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Rotation Summaries:

Primary Rotation

Orientation

Radiation Safety

Dosimetric Measurement Systems

Radiation Protection

Acceptance/Commissioning of medical accelerator

Quality Assurance of medical accelerator

Calibration of medical accelerator

Acceptance Testing and Quality Assurance of Conventional Simulator

Acceptance Testing and Quality Assurance of CT/PETCT

External Beam Treatment Planning 3D

External Beam Treatment Planning IMRT

Brachytherapy Prostate Seed Implants

Brachytherapy High Dose Rate

Gamma knife

Cyberknife

Eclipse Treatment Planning System

Medical Accelerator IMRS

Total Body Irradiation

Intensity Modulated Radiation Therapy

4D Computed Tomography

Physicist of the Day Responsibilities

Nuclear Medicine Lectures

Total Skin Electron Therapy Lectures

Special Shielding Lectures

Intraoperative Therapy Lectures

Medical Physics Lecture

Radiobiology Lecture

Educational Responsibilities

Tumor Boards

Journal Club

UPMC D3 eRounds

Weekly Chart Rounds

Physics Divisional Meetings

Catch up

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Orientation

Overview:

The objective of the orientation is to familiarize the resident to the hospital environment

and introduce to the resident the tasks the resident is expected to complete and become proficient

in. The director will discuss and follow the orientation handout covering a wide range of topics.

The resident is then tasked to become familiar with AAPM Reports 79 and 90, the residency log

and this residency task packet. A radiation safety overview will be conducted with a

questionnaire to be completed and returned to the director. Over two weeks, the resident will

observe CT simulation, each treatment machine, dosimetry and physics. An orientation

questionnaire will then be completed by the resident and submitted to the director.

Purpose:

For physics residents, the two week orientation should allow the resident time to see how

patients are simulated, image acquired and transferred to dosimetry, and then treatment. These

learning objectives will have the resident understand the patient workflow within the department.

The orientation is broken into two days. Day 1 is human resources orientation. Day 2 the

program is reviewed with the program director and all aspects of the residency are outlined. Then

the two week orientation begins after this day.

Tasks to complete/review for 2

nd day at Shadyside: Completed Not Completed

1. Human Resources Orientation ________ ____________

2. Definition of Medical Physicist ________ ____________

3. Code of Ethics ________ ____________

4. Department Policies and Procedures ________ ____________

5. Legal Aspects of Medical Physics ________ ____________

6. Radiation Safety ________ ____________

7. Mechanical Safety ________ ____________

8. Electrical Safety ________ ____________

9. Local AAPM Chapter (Penn-Ohio) ________ ____________

10. Organizations of Medical Physics ________ ____________

11. Credentialing / Equipment use ________ ____________

12. Residency Folder and location ________ ____________

13. Objectives and Task Groups ________ ____________

14. Tumor Boards, Journal Club, Visiting Lectures ________ ____________

15. Medical Physics Lecture ________ ____________

16. Radiation Biology Lecture ________ ____________

17. Physics Divisional Meeting ________ ____________

18. Weekly Chart Rounds ________ ____________

19. Journaling: Resident Progress ________ ____________

20. 2 week Orientation on Machines ________ ____________

21. Tuberculosis Testing ________ ____________

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22. Committees involved in Program ________ ____________

23. Pathways for Medical Physics ________ ____________

24. AAPM Rpt 90 and Rpt 79 ________ ____________

25. Residency Essentials for Passing ________ ____________

26. Passing versus Conditioning ________ ____________

27. Curriculum Evaluation ________ ____________

28. Schedule ________ ____________

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Orientation (continued)

The two week review and objectives the physics trainee will understand.

Tasks to complete:

1. CT Simulation (4 days)

a. What type of scanner (make and manufacturer) is at the UPMC Shadyside?

b. What is the purpose of the CT simulation?

c. What is the input from the radiation oncologist?

d. Describe the patient immobilization?

e. How many slices were taken? What was the length of the scan? What was the

slice thickness? What happened after the scan was done?

2. For Each Treatment Machine ( 1 day at each machine = 3 days)

a. How many therapists are on each machine? Are they all certified?

b. What type of accelerators were the resident on (make and manufacturer)?

c. What is special about this accelerator?

d. What are the available energies on this accelerator?

e. What is their average patient load?

f. What is the majority of the cases on this machine?

g. Describe the average case: number of fields, gantry, collimator, pedestal, and

blocking techniques.

h. How long is the average treatment time?

i. Are there any special treatment techniques on this machine? If yes, describe

briefly.

j. What does the electronic chart capture?

k. What is recorded daily in the hard chart?

3. Dosimetry (1day shared rotating time with each medical dosimetrist)

a. What is the purpose of Dosimetry?

b. What equipment does this department use for dosimetry? Planning systems?

Simulating systems?

c. What information does dosimetry need?

d. What is the output from dosimetry?

e. What is the average time to complete a 2D or 3D case?

4. Physics (1 day)

a. What role does physics play in the department?

b. What do they do with the plans?

c. What do they check on the linacs?

d. What checks happen at the end of treatment?

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Radiation Safety

Overview:

The radiation safety portion of the residency will take place under the supervision of the

Radiation Safety Officer for University of Pittsburgh. For the failure mode effects analysis

(FMEA) principles and applications will be supervised by Dr. Saiful M. Huq who is the chair of

the AAPM TG-100. Root cause analysis (RCA) principles and applications will be also mentored

by Dr. Huq. Evaluation of nuclear medicine procedures will be covered. Monitoring of radiation

personnel TLD badges will be discussed. Mock records of events, internal and reportable to the

state will be evaluated by the resident with the help of a staff physicist using web based Risk-

Master and form “Record of Event 11182011roe”. The ROE events are reviewed on a bi-

monthly basis at the departmental physics staff meeting. The Associate Director of the Medical

Physics Division will assign ROE analysis to the resident as they are submitted. Designing

radiation safety program will be discussed and the resident will analyze each of the rotations for

safety practices. A report will then be generated by the resident describing the results of the

analysis and recommendations.

Purpose:

The resident is expected to know appropriate institutional and state regulations pertaining

to the use, storage, transport and safety relating to ionizing radiation. The resident will know how

to calibrate and use a survey meter for the expressed purpose of assessing environmental levels

of radiation. The resident must be able to manage the ordering, receipt assay and disposal of all

radioactive sources they expect to use or would have responsibility for as a Radiation Safety

Officer (RSO). The resident should become familiar with radiation area designation and

monitoring, as well as event reporting guidelines and regulations. In addition to that, the resident

should be well aware of the FMEA and RCA principles and applications.

Tasks to complete:

The tasks for this rotation are for the resident to read, understand and apply the state and

federal regulations that pertain to radiation safety. The Radiation Safety Office and Radiation

Safety Committee implement these regulations. Examples of medical events will be reviewed

and the corrective actions applied in each case will be discussed. The resident will have hands on

verification of constancy for radiation equipment and assist in personnel dosimetry. These and

additional assignments will be saved by the resident.

Timeframe to complete tasks:

The radiation safety concepts are applied throughout residency. The resident will assist in

the quality assurance practices and develop policies and procedures throughout the residency.

Short Summary of Rotation

a) Regulations

1. Radionuclide management

2. Radionuclide containing patients

3. Medical events

4. State Regulations

5. Area designations

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b) Radiation protection/survey

1. Survey meter calibration

2. Neutron meter calibration

3. Personnel dosimetry

c) Personnel Monitoring

1. Radiation Badge

2. Reports and maintenance

d) Radiation Safety Training of Personnel

e) Low levels of radiation hazards/benefits

f) FMEA/RCA

Reading Assignments:

NRC Title 10

PA_code_25_219

PA_code_25_220

PA_code_25_228

RPT_56

RPT_71

RPT_160

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Dosimetric Measurements Systems

Overview:

Routine clinical measurements can only be performed if measurement equipment is

thoroughly investigated for stability and performance. The staff physicist will provide the

resident with document “Dosimetric Measurement Systems 11182011dms”. Within this

document is a series of tests that the resident will perform on various clinical equipment used

within the department. A report will be generated by the resident showing the measured results.

Purpose:

Proper care of sensitive radiation equipment is vital to measuring radiation distributions.

The resident will outline, carry out and discuss acceptance testing and maintenance of ion

chambers and electrometers, film and film scanners, mosfets, diodes and water phantom

scanners.

Tasks to complete:

Residents will perform measurements to ensure proper device response, perform quality

assurance on devices and document these results. These and additional assignments will be

saved by the resident.

Timeframe to complete tasks: 1 month.

Short Summary of Rotation

1. Ionization chamber and electrometer, TLD, MOSFET, Diode

1. Acceptance

2. Characteristics

3. Calibration

4. Uses

5. Quality Assurance

2. Temperature and pressure instrumentation

3. Film scanning systems: RIT software

1. Acceptance

2. H&D curve

3. Energy dependency

4. Modality dependence

5. Scanning

6. Construction

4. Water phantom scanners: Scanditronix-Wellhofer

1. Acceptance

2. Quality Assurance

3. Operation of software

Reading Assignments

Halverson

IAEA Dosimeters

IVD

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J. IZEWSKA Dosimeters

XR Hue Entrance dose diodes

EDR and Photons

EDR and Electrons

RPT_87

RPT_216

Low

Scanditronix-Wellhofer manual (available at Shadyside)

RIT film scanner (available at Shadyside)

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Radiation Protection

Overview:

To ensure safe radiation levels to workers as well as the general public the resident will

measure and calculate a designed vault within UPMC Shadyside. Application of workload, use

factor and occupancy factors as well as special procedures will give the resident an

understanding of the vault design. The resident will follow the document “Radiation Protection

11182011”. The resident will work with the Associate Director to design radiation shielding for

other vaults and circumstances, e.g., dedicated HDR suite. This will involve measurement and

calculations for existing vaults at Shadyside. The resident will also measure and calculate an

HDR vault at Shadyside. This rotation will cross over into brachytherapy as well. A report will

then be generated by the resident describing the calculations, reports submitted to state, and a

verification room survey.

Purpose:

To insure that environmental levels of radiation do not exceed those permitted by

applicable state and federal regulations.

Tasks to be completed:

Residents will follow appropriate task group reports to design and calculate appropriate

thickness of material to maintain state and federal regulations to maximum permissible doses to

the general public as well as radiation workers. This will be performed for at least 1 accelerator

vault and HDR vault and hotlab. Each topic below will be measured if applicable. These and

additional assignments will be saved by the resident.

Timeframe to complete tasks: 1 month.

Short Summary of Rotation

a. Linear Accelerator (low/high energy) with/without maze

1. Application of and definitions for Workload, Use and Occupancy Factor

2. Calculations for barrier thickness

3. Door specifications and design

4. Area designations

5. Verification of shielding values

6. ALARA

7. Special procedures

i. TBI

ii. TSET

iii. IMRT

b. Brachytherapy: HDR, LDR and source storage area

1. Room design/survey

2. Transportation procedures

3. Wipe tests

4. ALARA

c. CT and PET/CT shielding

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1. Application of and definitions for Workload, Use and Occupancy Factor

2. Calculations for barrier thickness

3. Door specifications and design

4. Area designations

Reading Assignments

NCRP 105

NCRP 107

NCRP 155

NCRP 151

NCRP 157

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Acceptance Testing and Commissioning of Medical Linear Accelerator

Overview:

If applicable, the resident will work closely with one or more physicists to perform an

acceptance and commissioning of a medical linear accelerator. If a machine is not being installed

over your two year residency a mock demonstration will be performed. The resident will perform

with a staff member document “Acceptance-Commissioning of medical accelerator doc

11182011acma”. This document outlines all of the tests the resident would perform with the

vendor representative to verify the system performance according to vendor and has met vendor

specifications. The resident will then perform a series of measurements for data collection to be

input into vendor treatment planning workstation. All tests are outlined within this document. A

report, use of Varian CAP documents, will then be generated by the resident describing the

measurements and measured results.

Purpose:

Residents are expected to perform acceptance testing and commissioning of medical

linear accelerators. The resident will conduct appropriate testing to insure head leakage of a

linear accelerator meets state/federal requirements and vendor provided specifications. The

resident will obtain all radiation beam measurements needed to calculate monitor units as well as

provide data for entry into treatment planning systems. The resident will learn to calibrate all

electron and photon beams on a linear accelerator with appropriate protocols. The resident will

accept and commission additional external devices used in a modern clinic.

Tasks to complete:

The resident will perform at least 1 acceptance and commissioning of a medical linear

accelerator if applicable; otherwise a mock commissioning will take place. The below

competencies will be measured using appropriate radiation equipment. These and additional

assignments will be saved by the resident.

Timeframe to complete tasks: 2 months if mock, otherwise according to site schedule.

Short Summary of Rotation

a) Acceptance testing and commissioning

1. Manufactures tolerance and specification of photon and electron beams

2. Mechanical Checks

3. Radiation Checks

4. Head leakage survey and measurement

5. Safety review and checklist

6. MLC

7. EPID (kV and MV)

8. Imagining cameras for patient setup

9. Respiratory motion cameras for patient tracking

b) Photon and Electron beam commissioning

a) Dosimetric Measurements for PBC, AAA, MC

b) Percentage depth dose, profiles and dependencies

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c) Flatness and Symmetry

d) Output factors and their dependence (Sc, Sp, Scp)

e) Cone factors

f) Wedge Factors

g) Arc Therapy

h) Tissue Phantom Ratios and Tissue Maximum Ratios

Reading Assignments:

RPT_19

RPT_106

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Quality Assurance of medical linear accelerator

Overview:

The resident will perform on a monthly basis spot checks required by regulation and

recommended by the AAPM. The resident will follow form “QA11182011” for the instructions

to the clinic “Monthly Checklist 11182011mx” for the medical linear accelerator and a form for

the imagining systems “Monthly Checklist 11182011is”. A report will then be generated by the

resident describing the measurements and measured results the resident would perform for your

quality assurance.

Purpose:

The quality assurance program of medical accelerators will be discussed. The resident

will perform all, if within department, monthly quality assurance checks for each medical

accelerator.

Tasks to complete:

The monthly review checklist for mechanical, radiation, safety and other measurements

are defined within departmental policy and procedure. Measured results will be reviewed by a

certified physicist and stored within the department monthly quality assurance binders. These

and additional assignments will be saved by the resident.

Timeframe to complete tasks:

Ongoing throughout residency. When the physics steering committee is satisfied with the

resident performance, the resident will perform ongoing throughout the residency.

Short Summary of Rotation

Radiation Checklist

1. Daily morning checks – review during 2nd

year of shadowing P.O.D.

2. Monthly quality checks – must complete 6 with staff

3. Annual quality checks – must complete 2 with staff

Imagining Checklist

1. kV tests – same as Monthly quality checks

2. CBCT tests – same as Monthly quality checks

Reading Assignments:

Bowtie Filter definitions

Clinac IEC Type Tests

RPT_46

RPT_47

RPT_72

RPT_142

Yoo_QA Program of OBI

Calibration of medical linear accelerator

Overview:

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Calibration of a medical linear accelerator will be performed under the supervision of

staff medical physicist. The resident will overlap the Quality Assurance of medical accelerator

with this rotation. The resident will follow form “Calibration 11182011cma”. A report will then

be generated by the resident describing the measurements performed and outlining the process of

adjusting the machine output.

Purpose:

To ensure the proper dose is administered to the patient. Calibration of medical linear

accelerators will follow guidelines of AAPM TG51 protocol.

Tasks to complete:

The resident will access the appropriate chamber and phantom to use for calibration and

the protocols defined by the AAPM. Measurements will be performed on a monthly basis as well

as annually and when commissioning of a medical linear accelerator takes place. These and

additional assignments will be saved by the resident.

Timeframe to complete tasks:

Ongoing throughout the residency. During monthly quality assurance, if the accelerator is

out of tolerance, the staff physicist will review dose and have the resident perform the

calibration.

Short Summary of Rotation

1. Chambers used for data acquisition

2. Phantoms used in data acquisition

3. Protocols (TG51 and TRS398) – must complete 4 at annuals or when available on a

monthly basis

Reading Assignments:

TG 21 (not applicable within our clinic but resident should be familiar with)

RPT_67

TRS398

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Acceptance Testing and Quality Assurance of Conventional Simulator

Overview:

Conventional simulations are performed for a variety of reasons. As of beginning of July,

2015, the conventional simulator is being decommissioning. Therefore, the resident will get a

training with the AAPM TG66 report as well as Linac-based simulation. A report will then be

generated by the resident describing the measurements and measured results the resident would

perform for your quality assurance.

Purpose:

To ensure correct placement of isocenter on a patient for clinical setups. Residents are

expected to perform quality assurance tests on a simulator following the recommendations of

AAPM TG66.

Tasks to Complete:

AAPM TG66 will be discussed with the mentor and Linac-based simulation will be

observed. Additional assignments will be given to the resident.

Timeframe to complete tasks:

1 month.

Short Summary of Rotation

Quality Assurances (mockup with Linac)

Acceptance of new machine (mockup with Linac)

1. Acceptance testing

2. Mechanical and digital indicators

3. Field wires

4. Cross hair stability

5. Optical distance indicator

6. Lasers

7. Fluoroscopy

8. Table movements

9. Mechanical tests

10. Radiation tests

11. Dose

Reading Assignments:

RPT_14

RPT_76

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Acceptance Testing and Quality Assurance of CT/PETCT simulator

Overview:

Computed tomography simulations are performed for a variety of reasons. The resident

will follow form “CT Simulator Quality Assurance 11182011ctsqa” and perform tasks for the

daily, monthly and annual checks specified with UPMC policies and procedures. A report will

then be generated by the resident describing the measurements and measured results the resident

would perform for your quality assurance

Purpose:

To ensure correct placement of isocenter on a patient and quality assurance practices to

ensure correct patient markings. Residents are expected to perform quality assurance tests on a

simulator following the recommendations of AAPM TG66.

Tasks to Complete:

Measurements will be made on a CT and PT/CT located at Shadyside Hospital.

Documentation will be kept within the department binder for monthly quality assurance. These

and additional assignments will be saved by the resident.

Timeframe to complete tasks:

1 month. When the physics steering committee is satisfied with the resident performance,

the resident will perform ongoing throughout the residency.

Short Summary of Rotation

Quality Assurance

1. Daily

2. Monthly – Must complete 2

3. Annual – Must complete 1

Intended uses

1. CT operation

2. Initial warm-up procedures

3. Routine scanning parameters

4. Isocenter placement

5. Fusion

6. Beam placement

7. Dicom standard (aria, eclipse, advantage workstation)

8. CT to electron density collection

Reading Assignments:

CT_artifact_Radiographics_Barrett

Goldman-1-Principles of CT and CT Technology

Goldman-2-Principles of CT-Radiation Dose and Image Quality

Goldman-3-Principles of CT-Multislice CT

Hara-Assessment of Patient Exposure to X-Radiation from SPECT-CT Scanners

sdarticle-Positron Emission Tomography-Computed Tomography

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RPT_76

RPT_83

RPT_108

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External Beam Treatment Planning 3D

Overview:

The resident will work with UPMC dosimetrists to perform treatment plans on a variety

of clinical cases within the department. Two treatment plans for each disease site should be

performed. The resident will track this information in the Resident Log of Tasks. A report will

then be generated by the resident describing the planning techniques and dose tolerances used.

Purpose:

The resident will be able to identify the necessity for and select the most appropriate

system(s) for immobilization of patients during external beam treatment and perform treatment

plans for various disease sites. The resident will also perform irregular and 3D treatment

planning for the sites specified below.

Tasks to be completed:

Treatment plans are to be completed for the following sites. Two plans per site, if

applicable, will be the minimum requirement. These and additional assignments will be saved by

the resident.

Timeframe to complete tasks:

1 month to complete at least half of required cases.

Short Summary of Rotation

1. External beam treatment planning (3D)

a. Breast

b. Prostate

c. Thoracic

d. Central Nervous System

e. Gynecological

f. Gastrointestinal

g. Head and Neck

h. Lymphoma

i. Melanoma

j. Sarcoma

k. Pediatrics

2. Immobilization techniques

3. Image Registration Techniques

Eclipse Rigid Registration

Velocity Deformable Registration

Reading Assignments:

Eclipse Treatment Planning Manuals (available at Shadyside)

Velocity Manual (Available at Shadyside)

Dose Tolerance Emami

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ICRU 50

ICRU 62

MU Calcs

Normal Tissue Calcs Burman

NTCP Kutcher

NTCP models

QUANTEC

RPT_23

RPT_32

RPT_62

RPT_81

RPT_85

RPT_92

RPT_99s

RPT_114

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Intensity Modulated Radiation Treatment and Planning (including D3 visit)

Overview:

The resident will work with UPMC SRS planning physicists and dosimetrists at D3 to

perform treatment plans on a variety of clinical cases within the department. Two treatment plans

for each disease site should be performed. The resident will track this information in the Resident

Log of Tasks. A report will then be generated by the resident describing the planning techniques

and dose tolerances used.

Purpose:

The resident will be able to identify and select the most appropriate technique for patients

receiving external beam IMRT treatment and perform treatment plans for various disease sites.

Tasks to be completed:

IMRT treatment plans are to be completed for the following sites. 2 plans per site, if

applicable, will be the minimum requirement. These and additional assignments will be saved by

the resident.

Timeframe to complete tasks:

2 month to complete at least half of required.

Short Summary of Rotation

1. External beam treatment planning (IMRT)

a. Breast

b. Prostate

c. Thoracic

d. Gynecological

e. Gastrointestinal

f. Head and Neck

g. Pediatrics

2. Immobilization techniques

Reading Assignments:

See 3D Treatment Planning

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Brachytherapy: Prostate Seed Implants

Overview:

The resident will work with staff physicists in the specialized procedure of prostate seed

implants. The resident will follow form “Brachytherapy 1182011psi” and perform the assaying

and quarterly checks. 10 treatment plans will be performed and more if time permits. The

resident will track this information in the Resident Log of Tasks. A report will then be generated

by the resident describing the planning techniques used and dose tolerances used. The resident

will also detail the Quality Assurance practices the resident will perform. No official form will

be offered as each case will present its own challenges for the resident to present.

Purpose:

Special procedures for the treatment of prostate cancer.

Tasks to be completed:

The resident will be able to perform acceptance testing, commissioning, treatment

planning, treatment support, quality assurance and other appropriate duties in support of offering

prostate seed implant brachytherapy to a patient.

A minimum of 10 patient plans will be performed.

Timeframe to complete tasks:

2 months in parallel to HDR. When the steering committee is satisfied with the resident

performance, the resident will perform ongoing throughout the residency.

Short Summary of Rotation

a) Treatment planning system

1. Acceptance Testing

2. Commissioning

3. Quality Assurance

b) Sources

1. Assay

2. Handling and licensing

3. Source calibration

4. Disposal (if applicable)

c) Clinical applications

1. Prostate seed implants (PSI)

2. Treatment Imagining

d) Treatment checks

1. Clinical Doses

2. Fractions

3. Dose rates specification

4. Treatment Anatomy

5. Pre treatment checks

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6. Treatment setup

7. Treatment delivery

8. Post treatment checks

9. Final chart check

10. Emergency Procedures

Reading Assignments

RPT_21

RPT_51

RPT_59

RPT_68

RPT_69

RPT_84

RPT_84_Errata

RPT_84s

RPT_89

RPT_98

RPT_128

UPMC Hillman Cancer Center Medical Physics Residency Program 24 | P a g e

Brachytherapy: High Dose Rate

Overview:

The resident will work with staff physicists in the specialized procedure of high dose rate

for gynecologic, breast and endobronchial cancer. The resident will follow form “Brachytherapy

11182011hdr” and perform the quarterly source exchange and quarterly treatment plan checks.

10 treatment plans will be performed per disease sites indicated below and more if time permits.

The resident will track this information in the Resident Log of Tasks. A report will then be

generated by the resident describing the planning techniques and dose tolerances used. The

resident will also detail the Quality Assurance practices the resident will perform. No official

form will be offered as each case will present its own challenges for the resident to present.

Purpose:

Special procedures for the treatment of gynecologic, breast and endobronchial cancer.

Tasks to be completed:

The resident will be able to perform acceptance testing, commissioning, treatment

planning, treatment support, quality assurance and other appropriate duties in support of offering

high dose rate brachytherapy to a patient. A minimum of 10 patient plans will be performed.

Timeframe to complete tasks:

2 months in parallel to PSI. When the steering committee is satisfied with the resident

performance, the resident will perform ongoing throughout the residency.

Short Summary of Rotation

a) Treatment planning system

1. Acceptance Testing

2. Commissioning

3. Quality Assurance

b) Sources

1. Handling and licensing

2. Source calibration

3. Disposal (if applicable)

c) Clinical applications

1. Gynecologic – Tandem and Ovoids, Ring and Tandem, Syed

2. Endobronchial – if possible

3. Mammosite – if possible

d) Treatment checks

1. Clinical Doses

2. Fractions

3. Dose rates specification

4. Treatment Anatomy

5. Pre treatment checks

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6. Treatment setup

7. Treatment delivery

8. Post treatment checks

9. Final chart check

10. Emergency Procedures

Reading Assignments

RPT_41

RPT_61

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Gammaknife

Overview:

The resident will work with board certified medical physicists in the specialized

procedure of Gammaknife. For mechanical verifications the resident will follow form

“Gammaknife 11182011gk” and perform the daily, monthly and annual checks. 10 treatment

plans will be performed and more if time permits. The resident will track this information in the

Resident Log of Tasks. A report will then be generated by the resident describing the planning

techniques used and what are the dose tolerances to critical structures. The resident will also

detail the Quality Assurance practices the resident will perform. No official form will be offered

as each case will present its own challenges for the resident to present.

Purpose:

Special procedures for the treatment of cranial based lesions.

Tasks to be completed:

The resident will be able to perform acceptance testing, commissioning, treatment

planning, treatment support, quality assurance and other appropriate duties in support of offering

gammaknife to a patient. A minimum of 10 patient plans will be performed as well as 14 daily

quality assurance checks, 1 monthly and 1 annual. These and additional assignments will be

saved by the resident.

Timeframe to complete tasks:

1 month except annuals and monthlies. The annual will be coordinated with the site

physicist.

1. Clinical Goals

2. Acceptance Testing and Commissioning

3. Daily Quality Assurance – Must complete 14

4. Monthly Quality Assurance – Must complete 1*

5. Annual Quality Assurance – Must Complete 1* (revised on 2/29/16 due to data

inconsistency)

6. Images acquisition for treatment (MRI)

7. Treatment Setup

8. Treatment Planning

9. Emergency Procedures

Reading Assignments

RPT_68

Jen-San

Mack

Elekta Gammaknife manuals for Planning (available at Presbyterian Hospital)

UPMC Hillman Cancer Center Medical Physics Residency Program 27 | P a g e

Cyberknife

Overview;

The resident will work with staff physicists in the specialized procedure of Cyberknife.

For mechanical verifications the resident will follow form “Cyberknife 11182011ck” and

perform the daily “Cyberknife 11182011daily”, monthly “Cyberknife 11182011monthly” and

annual checks “Cyberknife 11182011annual”. 20 treatment plans will be performed and more if

time permits. The resident will track this information in the Resident Log of Tasks. A report will

then be generated by the resident describing the planning techniques used and what are the dose

tolerances. The resident will also detail the Quality Assurance practices the resident will

perform. No official form will be offered as each case will present its own challenges for the

resident to present.

Purpose:

Special procedures for the treatment of cranial, thoracic and abdominal based lesions.

Tasks to be completed:

The resident will be able to perform acceptance testing, commissioning, treatment

planning, treatment support, quality assurance and other appropriate duties in support of offering

Cyberknife to a patient. A minimum of 10 patient plans will be performed as well as 14 daily

quality assurance checks, 1 monthly and 1 annual. These and additional assignments will be

saved by the resident.

Timeframe to complete tasks: 1 month except annuals and monthlies. The annual will be

coordinated with the site physicist.

Short Summary of Rotation

1. Clinical Goals

2. Acceptance Testing and Commissioning

3. Daily Quality Assurance – Must complete 14

4. Monthly Quality Assurance – Must complete 1* (revised on 2/29/16 due to data

inconsistency)

5. Annual Quality Assurance – Must complete 1

6. Images acquisition for treatment (MRI)

7. Treatment Setup

8. Treatment Planning

9. Emergency Procedures

Reading Assignments

Cyberknife training manuals for Planning (available at Shadyside)

UPMC Hillman Cancer Center Medical Physics Residency Program 28 | P a g e

Eclipse Treatment Planning Software

Overview:

Correct dose distributions displayed within treatment planning software must be

evaluated and spot checked over its lifetime. The resident will follow form “Eclipse

11182011etps” which outlines the acceptance tests, quarterly dose calculations, and data import

from commissioning to ensure that the treatment planning software is functioning. This rotation

will overlap with the acceptance/commissioning of medical accelerator. The resident will detail

the Quality Assurance practices the resident will perform in the clinic for treatment planning

systems.

Purpose:

Modern hospital based radiation oncology departments have three dimensional treatment

planning. Correct configuration, modeling of treatment unit and appropriate quality assurance

will ensure that the treatment planning software has not changed over time or from upgrades.

The resident will perform a series of exercises to boost their understanding of Eclipse.

Tasks to be completed:

The resident will perform acceptance testing and commissioning of treatment planning

software. The resident will perform quarterly quality assurance as outlined in AAPM TG53 and

UPMC Policies and Procedures. Upon commissioning, or may be supplied by staff, a medical

accelerator the data will be used to model a radiation machine in Eclipse. Appropriate quality

assurance will then be applied to the treatment planning software and medical accelerator. These

and additional assignments will be saved by the resident.

Timeframe to complete tasks:

Ongoing throughout residency.

Short Summary of Rotation

1. Acceptance Testing

2. Commissioning

3. Quality Assurance – Must Complete 2

4. Eclipse data import

5. Eclipse data modeling

6. Eclipse data verification

7. Monitor Unit Calculations

a. Acceptance

b. Commissioning

c. Quality Assurance

d. Algorithms of PBC, AAA, MC

e. Dose calculations, MU

i. photons

ii. electrons

iii. dosimetry chart checks

UPMC Hillman Cancer Center Medical Physics Residency Program 29 | P a g e

Reading Assignments

AAA photon dose

AcurosXBClinicalPerspectives_RAD10156_October

ebd_collectionguide_v0.3na

ec_electbeamconfig7224ggpb

RPT_62

UPMC Hillman Cancer Center Medical Physics Residency Program 30 | P a g e

Medical Linear Accelerator Stereotactic IMRS

Overview:

The resident will work with certified physicists in the specialized procedure of

Stereotactic Radiosurgery/Radiotherapy. For mechanical verifications the resident will follow

form “Medical Acc. IMRS 11182011maimrs” and perform the daily, monthly and annual checks.

10 treatment plans will be performed and more if time permits. The resident will track this

information in the Resident Log of Tasks. A report will then be generated by the resident

describing the planning techniques used and what are the dose tolerances. The resident will also

detail the Quality Assurance practices the resident will perform.

Purpose:

Special procedures for the treatment of cranial, pelvic and thoracic based lesions.

Tasks to be completed:

The resident will be able to perform acceptance testing, commissioning, treatment

planning, treatment support, quality assurance and other appropriate duties in support of offering

medical accelerator based stereotactic radiosurgery/radiotherapy to a patient. A minimum of 10

patient plans will be performed as well as 14 daily quality assurance checks. These and

additional assignments will be saved by the resident.

Timeframe to complete tasks:

1 month. The annual will be coordinated with the site physicist.

Short Summary of Rotation

1. Clinical Goals

2. Acceptance Testing and Commissioning

3. Daily Quality Assurance – Must complete 14

4. Monthly Quality Assurance – Must complete 5

5. Annual Quality Assurance – Must complete 2

6. Images acquisition for treatment (MRI)

7. Treatment Setup

8. Treatment Planning

9. Emergency Procedures

Reading Assignments

RPT_54

RPT_101

RPT_135

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Total Body Irradiation

Overview:

The resident will work with staff physicists in the procedure for total body irradiation.

For dose calculations and measurements the resident will follow form “Total Body Irradiation

11182011tbi” and perform calculations and measurements. 10 treatment plans will be performed

and more if time permits. The resident will track this information in the Resident Log of Tasks.

A report will then be generated by the resident describing the measured and planning techniques

used and what are the dose tolerances to critical structures. No official form will be offered as

each case will present its own challenges for the resident to present.

Purpose:

Special procedures for the treatment of leukemia.

Tasks to be completed:

The resident will be able to perform acceptance testing, commissioning, treatment

planning, treatment support, quality assurance and other appropriate duties in support of offering

total body irradiation to a patient. A minimum of 10* patient plans will be performed through

patient contact or by mock examples.(revised on 2/29/16 due to data inconsistency) These and

additional assignments will be saved by the resident.

Timeframe to complete tasks:

Ongoing throughout residency.

Short Summary of Rotation

1. Clinical Goals

2. Quality Assurance

3. Treatment Setup

4. Treatment Planning

5. Dosimetry Measurements

6. Shielding critical structures

7. Dose Calculation

8. Calibration

Reading Assignments

RPT_17

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QA for Intensity Modulated Radiation Therapy

Overview:

The resident will perform patient specific quality assurance for plans of intensity

modulation. A total of 50 measurements, 25 measurements for IMRT and 25 measurements of

IMRS will be performed. These will be documented in the patient charts as well as the Resident

Log of Tasks. The resident will follow form “IMRT QA 11182011imrt”.After successful

demonstration the resident will be credentialed in this procedure and expected to assist staff and

perform this independently.

Purpose:

Special procedures for the treatment of various disease sites in both traditional and hyper-

fractionated dose regiments.

Tasks to be completed:

The resident will be able to perform acceptance testing, commissioning, treatment

planning, treatment support, quality assurance and other appropriate duties in support of offering

intensity modulated radiation therapy to a patient. Some tasks will be covered in the Acceptance

and Commissioning of a Medical Linear Accelerator. These and additional assignments will be

saved by the resident.

Timeframe to complete tasks:

Is ongoing throughout the residency. When the steering committee is satisfied with the

resident performance, the resident will perform ongoing throughout the residency.

Short Summary of Rotation

1. Clinical Goals

2. Quality Assurance

3. Treatment Setup

4. Treatment Planning

Reading Assignments

Low

RPT_72

RPT_82

RPT_120

UPMC Hillman Cancer Center Medical Physics Residency Program 33 | P a g e

4D Computed Tomography

Overview:

The resident will analyze 20 patient motion scans to determine tumor motions. The

resident will follow form “4DCT Motion 111820114dct” and work with a staff physicist to learn

and understand the procedure employed at UPMC for 4D studies and their analysis. After the

resident complete half of these cases and demonstrate knowledge of material, the resident will be

credentialed and work independently on the remainder.

Purpose:

The resident will be able to instruct therapists, coach patients and analyze computed

tomography scans that utilize external motion tracking hardware and software for tumor motion.

Tasks to be completed:

The 4D computed tomography rotation teaches the resident the appropriate protocols and

planning techniques required to ensure proper delineation of tumor motion. Residents will

measure, evaluate and assist in patient treatment. This information will be stored within the

patient record. A minimum of 10 patients are to be analyzed. These and additional assignments

will be saved by the resident.

Timeframe to complete tasks:

1 month. When the physics review committee is satisfied the resident will perform

ongoing throughout the residency.

Reading Assignments

GUIDELINES AND TECHNIQUES FOR IMAGE-GUIDED RADIOTHERAPY FOR NON–

SMALL CELL LUNG CANCER

Low-Clinical Use of 4-D CT

RPT_91

RPT_91-a

UPMC Hillman Cancer Center Medical Physics Residency Program 34 | P a g e

Nuclear Medicine

Overview:

The resident will work with the radiation safety office in the study of sir spheres, thyroid

ablation and other nuclear medicine procedures. ”Patient Contact” form will be filled out by the

resident through procedures performed at UPMC.

Purpose:

Liver ablation, thyroid scans, etc… are part of the treatment and imagining techniques

that the resident will be expected to learn in the radiation safety department.

Tasks to be completed:

This competency is a reading and lecture based assignment. A minimum of 5 cases will

be presented by the resident. These and additional assignments will be saved by the resident.

Timeframe to complete tasks:

Is ongoing throughout the residency and will be coordinated by the radiation safety

department.

Short Summary of Rotation

1. Clinical Goals

2. Quality Assurance

3. Treatment Planning

4. Assaying

5. State and federal regulations

6. Calculations involving dose

Reading Assignments

To be determined by radiation safety officer.

UPMC Hillman Cancer Center Medical Physics Residency Program 35 | P a g e

Total Skin Electron Therapy

Overview:

This lecture will cover the basic application of total skin electron therapy and outline the

measurements to perform, the clinical objectives and the difficulties of this procedure. Only a

lecture will be provided.

Purpose:

Special procedures for the treatment of whole body skin malignancies.

Tasks to be completed:

This competency is a reading and lecture based assignment. Calculations from measured

profiles, dose determination, patient setup and room design will be discussed. Additional

assignments will be saved by the resident.

Timeframe to complete tasks:

1/2 month.

Short Summary of Lectures

1. Clinical Goals

2. Quality Assurance

3. Treatment Setup

4. Treatment Planning

5. Dosimetry Measurements

6. Shielding of critical structures

7. Dose Calculation

8. Calibration

Reading Assignments

RPT_23

UPMC Hillman Cancer Center Medical Physics Residency Program 36 | P a g e

Special Shielding

Overview:

This lecture will cover the basic applications of shielding and outline the measurements

to perform. Shielding for pacemakers, lens of eyes, testicular and pregnancy will be discussed.

Purpose:

The resident will assist in determining the appropriate shielding needed for the desired

clinical goal.

Tasks to be completed:

This competency is a reading and lecture based assignment. The special shielding

rotation teaches the resident the appropriate protocols and planning techniques required to block

radiation to patient critical structures. Residents will measure, evaluate and assist in patient

treatment. This information will be stored within the patient record. These and additional

assignments will be saved by the resident.

Timeframe to complete tasks: is ongoing throughout the residency.

Short Summary of Lectures

1. Clinical Goals

2. Quality Assurance

3. Treatment Planning

Reading Assignments

RPT_50

RPT_45

UPMC Hillman Cancer Center Medical Physics Residency Program 37 | P a g e

Intraoperative Radiotherapy

Overview:

This lecture will cover the basic application of intraoperative therapy and outline the

measurements to perform, the clinical objectives and the difficulties of this procedure. Only a

lecture will be provided.

Purpose:

This special procedure involves utilizing mobile or stationary medical accelerators to

treat patients with high energy electrons and direct contact with the tumor.

Tasks to be completed:

This competency is a reading and lecture based assignment. Calculations from measured

profiles, dose determination, patient setup and room design will be discussed. Additional

assignments will be saved by the resident.

Timeframe to complete tasks:

1/2 month.

Short Summary of Lectures

1. Clinical Goals

2. Quality Assurance

3. Treatment Setup

4. Treatment Planning

5. Dosimetry Measurements

6. Shielding of critical structures

7. Dose Calculation

8. Calibration

Reading Assignments

RPT_92

RPT_92MPSynopsis

TF48

Physicist of the Day Responsibilities

Purpose: The resident will participate in the routine clinical responsibilities of a medical

UPMC Hillman Cancer Center Medical Physics Residency Program 38 | P a g e

physicist including checking patient plans and Aria record and verify checks, patient simulation

and clinical coverage. The resident will perform this rotation with guidance from certified

medical physicist for the first year. The second year the resident will perform independent plan

reviews and record and verify review before the patient is treated and this will be reviewed by

certified physicists and tracked within the patient chart. These and additional assignments will be

saved by the resident.

Timeframe to complete competencies is ongoing throughout the residency.

UPMC Hillman Cancer Center Medical Physics Residency Program 39 | P a g e

Rotation Schedule 1

ST Year

Title of Rotation Timeframe (month(s)) Mentor

Program Orientation ½ Si Young Jang

Radiation Safety (First Half) ½ Michael Sheetz

Dosimetric Measurement Systems ½ Si Young Jang

Quality Assurance of Medical Accelerator 1 Kevin Fallon

4D CT (in parallel with QA of CT simulator) 1 Dariusz Michalski

Calibration of medical accelerator 1 Saiful Huq

Radiation Protection 1 Greg Bednarz

Treatment Planning System 1 Si Young Jang/SRS

planning physicists

IMRT 1 Ron Lalonde/SRS

planning physicists

3D/Treatment Planning (including D3 visit) 2 Chuck McCoy/Tianfang Li

Acceptance test and Commissioning

of medical accelerator 2 Si Young Jang

/Kevin Fallon

Acceptance Testing /QA of CT Simulator-PETCT ½ Si Young Jang /Ron Lalonde

Rotation Schedule 2

ND Year

Radiation Safety (Second Half: ROE,FMEA) ½ Michael Sheetz/Saiful Huq

/Greg Bednarz

Brachytherapy: PSI (in parallel with HDR) 2 Chris Houser

Brachytherapy: HDR (in parallel with PSI) 2 Hayeon Kim

Acceptance Testing /QA of Simulator 1 Kevin Fallon

Medical Accelerator based IMRS/SBRT 1 Fang Li

Cyberknife 1 Cihat Ozhasoglu

Gammaknife 1 Greg Bednarz/

Jagdish

Bhatnagar*(revised on 1/7/16

since Dr. Xu left)

TBI ½ Ron Lalonde/ Kevin Fallon

Nuclear Medicine ½ Michael Sheetz/

Si Young Jang

Total Skin Electron Therapy ½ Saiful Huq

Intraoperative Therapy ½ Kevin Fallon

Shielding for special clinical situations ½ Kevin Fallon/Saiful Huq

Physicist of the Day 12 resident shadowing POD

Catch up-Finalize paperwork 1 Si Young Jang

UPMC Hillman Cancer Center Medical Physics Residency Program 40 | P a g e